Ontario’s position on midwifery puts rural and Indigenous communities at risk

On Nov. 10, Ontario’s Ford government appealed – for the second time – a ruling that supports midwives’ claims of gender-based pay inequity. As two young professionals entering health care, we are concerned about the government’s discrimination against midwifery, specifically against its scope of aiding rural, northern and Indigenous communities.

We ask: How far will Ontario go to show midwives (and their clients) that they’re not valued?

In 2018 and again in 2020, the Human Rights Tribunal of Ontario (HRTO) supported a 2013 complaint of gender-based pay inequities. The finding – that some of the work midwives perform is similar to that of physicians and should be paid accordingly – was upheld by Ontario’s Divisional Court in 2020 but the Ford government is now turning to the Ontario Court of Appeal.

The midwifery profession is at particular risk of gender-based discrimination – the workforce is mostly female and caters to people (or clients) identifying as women. Noting that the salary gap for similar work between midwives and physicians increased from $3,000 when midwifery was added to the public health system in 1994 to $100,000 by 2010, the HRTO ruled midwives were entitled to a 20 per cent retroactive, ongoing equity adjustment. Despite the retroactive increase, the gap has now grown to $126,000.

According to the Ford government, these demands for equity are unacceptable. But instead of using tax dollars to fight midwives in court, the Ford government should recognize the legitimacy of gender-based inequities, address the pay gap and invest in rural and northern programs, such as the recently axed Laurentian University midwifery program.

The growing trend of urbanizing health services means fewer family physicians are learning obstetrical skills for rural practice. With only four per cent of obstetricians choosing to practice rurally, and already long waitlists for midwives, rural areas are becoming deserts for available birthing services. In some small rural hospitals, nurses may be the only ones attending to a labouring individual while physicians and other professionals are on call.

Lack of services means some women must travel away from the community to give birth – in many Indigenous communities, patients have to travel more than 200 kilometres – a practice that has been associated with adverse health outcomes, including increased perinatal mortality, undue stress and trauma and financial burdens.

Historically, incentive programs have been put in place to encourage rural practice, but funding inequities among professionals have been a consistent issue. In appealing the midwifery pay inequity ruling, the Ford government reinforces the notion that midwives and the work they provide are not valued equally.

How far will Ontario go to show midwives (and their clients) that they’re not valued?

The appeals are only one way this government opposes midwives’ ability to bring safe births to rural communities. Last June’s announcement of Laurentian University’s insolvency marks the loss of its midwifery program, the only one dedicated to keeping midwives in northern Ontario. With specialized francophone and Indigenous streams, it had provided a vital link to culturally sensitive obstetrical care in rural, and particularly Indigenous, communities.

The growing trend in Indigenous communities toward Indigenous midwifery and doula services has successfully returned birthing services to several Indigenous communities across the country, such as in Nunavik, Que., and reflects a narrative of reclaiming sovereignty over the birthing process.

This provincial government’s inability to save the Laurentian midwifery program, along with the continuous pay equity appeal process, demonstrates to rural and Indigenous communities that this government does not recognize their distinct needs or their unique adverse health outcomes.

As two students in health-care professions (in school for medicine and midwifery), we are concerned about the impact the appeals process and the devaluing of the midwifery profession will have on our future rural and northern patient populations. We must condemn the dangerous implications this will have on access to rural and culturally safe obstetrical care and its threat to an Indigenous sovereign future.